van der Burg Alida E Borger, Bax Jeroen J, Boersma Eric, Pauwels Ernest K J, van der Wall Ernst E, Schalij Martin J
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Circulation. 2003 Oct 21;108(16):1954-9. doi: 10.1161/01.CIR.0000091410.19963.9A. Epub 2003 Oct 6.
Survivors of aborted sudden death attributable to ventricular arrhythmias in the presence of coronary artery disease are at risk for recurrences. The substrate underlying these arrhythmias is not clear, and therefore the relation between ischemia, viability, scar tissue (and revascularization), and the incidence of ventricular arrhythmias (and survival) was studied over up to 3 years.
One hundred fifty-three survivors of sudden death underwent stress-rest perfusion imaging. Patients with ischemic/viable myocardium (n=73) were revascularized if possible. Final antiarrhythmic therapy was based on the outcome of electrophysiological testing or left ventricular ejection fraction (LVEF). Implantation of a defibrillator was performed in 112 (72%) patients. During 3-year follow-up, 15 cardiac deaths occurred and 42 (29%) patients had recurrent ventricular arrhythmias. Patients with events (death or recurrence) exhibited more often a severely depressed LVEF (< or =30%), more extensive scar tissue, and less ischemic/viable myocardium on perfusion imaging and less frequently underwent revascularization. Multivariate analysis identified extensive scar tissue and LVEF < or =30% as the only predictors of death/recurrent ventricular arrhythmias.
In patients with aborted sudden death, extensive scar tissue and severely depressed LVEF are the only predictors of death or recurrent ventricular arrhythmias. These patients should be considered for implantation of a defibrillator.
在存在冠状动脉疾病的情况下，因室性心律失常导致心脏骤停但复苏成功的患者有复发风险。这些心律失常的潜在基质尚不清楚，因此对缺血、存活心肌、瘢痕组织（以及血运重建）与室性心律失常发生率（及生存率）之间的关系进行了长达3年的研究。
153例心脏骤停复苏成功的患者接受了负荷-静息灌注成像检查。对于存在缺血/存活心肌的患者（n = 73），尽可能进行血运重建。最终的抗心律失常治疗基于电生理检查结果或左心室射血分数（LVEF）。112例（72%）患者植入了除颤器。在3年的随访期间，发生了15例心源性死亡，42例（29%）患者出现复发性室性心律失常。发生事件（死亡或复发）的患者在灌注成像中更常表现为LVEF严重降低（≤30%）、瘢痕组织范围更广、缺血/存活心肌更少，且接受血运重建的频率更低。多变量分析确定广泛的瘢痕组织和LVEF≤30%是死亡/复发性室性心律失常的唯一预测因素。
在心脏骤停复苏成功的患者中，广泛的瘢痕组织和严重降低的LVEF是死亡或复发性室性心律失常的唯一预测因素。这些患者应考虑植入除颤器。
